Predictors of 2-Year Drinking Outcomes in a Swedish Treatment Sample.

Background: Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples.

Methods: Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes.

Results: Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence.

affiliation with Alcoholics Anonymous increased the likelihood of 2nd year abstinence

Satisfaction with treatment and affiliation with the 12 Step group Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence.

Conclusion: Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.

Research; Maria C. Bodin & Anders Romelsjö. Predictors of 2-Year Drinking Outcomes in a Swedish Treatment Sample. European Addiction Research 2007;13:136-143

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Alcoholics show deficits in their ability to perceive dangerous situations

• Previous brain-imaging studies have suggested cognitive deficits in alcoholic patients.
• New findings indicate that alcoholic patients show emotional processing deficits as well.
• These deficits primarily affect processing for negative emotional expressions.

Alcoholics tend to be deficient in both cognitive and emotional processes.

Previously, most brain-imaging research focused on cognition rather than emotion. A new study uses functional magnetic imaging (fMRI) to examine emotional processing, finding that alcoholics have stunted abilities to perceive dangerous situations.

Results are published in the September issue of Alcoholism: Clinical & Experimental Research.

“We knew that alcoholics show a deficit in accurate recognition of facial emotions,” said Jasmin B. Salloum, research scientist at the National Institute on Alcohol Abuse and Alcoholism and corresponding author for the study. “This can lead to insensitivity to, and overestimation and/or misattribution of, certain facial expressions.”

“Relatives and friends of alcoholics often wonder why they continue to drink even though they intellectually know how detrimental this is for them,” added Andreas Heinz, director and chair of the department of psychiatry at Charité – University Medical Center Berlin. “Patients often relapse when entering previous drinking situations, that is, entering a bar or a shop in which you can buy alcoholic drinks. One reason may be that they fail to perceive dangerous situations. This study suggests that there is a neurobiological correlate of this often-reduced ability to perceive dangerous situations.”

Study participants comprised 11 male subjects who met DSM-IV criteria for alcohol dependence, as well as 11 healthy male subjects or “controls.” All participants were given a facial-emotion decoding task during which they were asked to determine the intensity level of a target emotion displayed via facial expressions of happy, sad, anger, disgust and fear. Researchers used fMRI to examine the subjects’ brain-blood oxygenation level dependent (BOLD) responses (a BOLD signal will increase when that part of the brain is engaged in active processing of information).

Results showed that the greatest deficit among the alcohol-dependent individuals was in brain activation during decoding of negative emotional expressions, particularly in the affective division of the anterior cingulate cortex. The anterior cingulate is part of the prefrontal brain area.

“The cingulate is involved in many higher order executive functions such as focused attention, conflict resolution and decision making,” said Salloum. “Alcoholic patients are known to be sensation seekers and are less likely to shy away from signals that suggest danger. Both sensation seeking and avoidance of danger are characteristic of subjects with axes II personality disorders, which many of our subjects had. The findings in this study may shed some light on some of the problematic and psychopathological behaviors that are manifest in this patient group. It remains to be determined if the dysfunction of the anterior cingulate precedes alcoholism or is a result of long term drinking.”

There is, however, a silver lining, added Heinz. “Now we can begin to understand why patients have problems avoiding dangerous situations and, particularly, why they may not react to the concerns of their friends and relatives: the brain area that should help them appreciate these concerns is functioning at a reduced level. Furthermore, the authors also observed a normal or even increased brain response to happy faces. Our group recently made a similar observation, in that patients with strong brain responses to pleasant pictures have a reduced relapse risk. So, relatives and friends may want to support alcoholic patients with positive messages that strengthen their self-esteem while being particularly careful, and even repetitive, in pointing out the dangers of alcohol and alcohol-associated environments. Otherwise, the patients may miss the message.”

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Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study.

Three hundred alcoholic patients were interviewed at hospitalisation and again 3 and 6 months thereafter in Porto Alegre, Brazil, from March 2002 to January 2004.

Assessment included the SCID-I to check for the presence of Axis I mental disorders, a questionnaire focusing on patient relationship with AA groups, and specific questions about participation in psychotherapy. A logistic regression analysis was performed to determine predictive variables for relapse or abstinence 6 months after discharge.

Previous treatment for alcohol dependence and being single proved to be associated with relapse,

Findings; adherence to AA, the presence of a comorbid depressive disorder, and probably adherence to psychotherapy could be associated with abstinence.

adherence to AA could be associated with abstinence

These findings reinforce the importance of psychotherapy and AA groups for alcoholics to remain abstinent for longer.

The greater adherence to treatment observed among depressive alcohol dependents can be explained by the fact that this is a comorbid condition that acts as a protective factor against relapse.

Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study. Subst Use Misuse. 2008;43(3):403-11. Terra MB, Barros HM, Stein AT, Figueira I, Athayde LD, Ott DR, De Azambuja Rde C, Da Silveira DX.

See also;

• Brief-TSF is designed to address these issues.
• 12-Step Treatment More Effective than Alternative
• Subscribe to BriefTSF by e-Mail

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Persistent influence of social networks and Alcoholics Anonymous on abstinence

The role of changes in Alcoholics Anonymous (AA) involvement and social networks in relation to abstinence following substance abuse treatment is studied.

Specifically, the role of AA and network support for abstinence are examined in relation to their effect on changes in abstinence states between follow-ups. Study sites were 10 representative public and private alcohol treatment programs in a northern California county.

A recruitment of 367 men and 288 women seeking treatment were interviewed at intake and re-interviewed 1 and 3 years later to collect information about alcohol consumption, dependence symptoms, social support for reducing drinking, number of heavy drinkers in the social network and AA involvement.

Significant predictors of 90-day abstinence at both the 1- and 3-year follow-up interviews included AA involvement in the last year, percentage of heavy or problem drinkers in the social network, percentage encouraging alcohol reduction and AA-based support for reducing drinking.

Panel models estimated an increase in AA participation between 12 and 36 months post-treatment increased the odds of abstinence at 3 years by 35% above those at 12 months.

The only significant mediator of AA’s effect on abstinence was the number of AA-based contacts supporting reduced drinking, which reduced the magnitude of the relationship by 16%. It is concluded that AA involvement and the type of support received from AA members were consistent contributors to abstinence 3 years following a treatment episode.

Research report; Bond, J.; Kaskutas, L.A.; Weisner, C. Persistent influence of social networks and Alcoholics Anonymous on abstinence. Journal of Studies on Alcohol, 64(4):579-588, 2003.

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Project MATCH client impressions about Alcoholics Anonymous: Measurement issues and relationship to treatment outcome.

Alcoholics Anonymous (AA) is the most popular mutual-help program for individuals with alcohol-related problems, and most treatment programs encourage AA attendance during and after treatment.

As part of a larger study (Project MATCH), this study examined aftercare and outpatient client subjective impressions about AA.

As predicted, client ratings of the helpfulness of AA, the importance of encouragement to attend AA, spiritual experiences, and God consciousness were positively related with AA meeting attendance and practicing of prescribed AA-related behaviors, such as having a sponsor.

Confirmatory factor analyses indicated that commitment to AA-related practices, AA meeting attendance, and subjective impressions about AA formed a single latent construct depicting how individuals experience AA.

Increased engagement in AA-related practices and beliefs was predictive of statistically significantly more abstinence and less intense drinking when drinking occurred.

Tonigan, J.S.; Miller, W.R.; Connors, G.J. Project MATCH client impressions about Alcoholics Anonymous: Measurement issues and relationship to treatment outcome. Alcoholism Treatment Quarterly, 18(1):25-41, 2000.

Living Sober by AA Services Read more about this title…

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Combined Alcoholics Anonymous and professional care for addicted physicians

We surveyed 100 impaired physicians who were successfully treated in a substance abuse program that combined professionally directed treatment and peer-led self-help.

An average of 33.4 months after admission, subjects reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities.

Feelings of affiliativeness to AA, which were very high, were strong predictors of subjects perceived support for their recovery.

Three psychological variables were seen as influential to this process:

• shared belief,
• group cohesiveness, and
• mutual identification.

Feelings of affiliativeness and an identification with the role of care giver in addiction treatment appeared to be central to subjects recovery process.

Research report; Galanter, Marc; Talbott, Douglas; Gallegos, Karl; Rubenstone, Elizabeth. Combined Alcoholics Anonymous and professional care for addicted physicians. American Journal of Psychiatry. Vol 147(1), Jan 1990, 64-68.

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A Hazard to the Non-drinking Alcoholic

When an alcoholic stops drinking, it’s cause for rejoicing.

Unfortunately, sobriety is not guaranteed to last. It takes hard work and commitment and a keen eye for dangers.

One danger to the non-drinking alcoholic is the dry drunk, a set of habits and attitudes that take the joy out of life for the alcoholic and those around him or her. Those habits often precede a relapse into drinking, even if the alcoholic has been sober for years.

A dry drunk can be successfully treated. Here are some signs that will help you recognize the condition, and some suggestions on how to cope with it.

Warning Signs

During their drinking years, alcoholics develop many abnormal attitudes and behaviors, which come with them into sobriety, and are characteristic of the dry drunk. Often, family members don’t recognize the symptoms of a dry drunk as anything unusual, since they have become so used to the abnormal behavior of the alcoholic.

Some typical signs of a dry drunk are:

• acting self-important, either by “having all the answers,” or playing “poor me.”
• making harsh judgments of oneself and others.
• being impatient or pursuing whims.
• blaming others for shortcomings one suspects in oneself.
• being dishonest, usually beginning with little things.
• impulsive behavior which ignores what’s best for oneself and others.
• inability to make decisions.
• mood swings, trouble with expressing emotions, feeling unsatisfied.
• detachment, self-absorption, boredom, distraction or disorganization.
• nostalgia for the drinking life.
• fantasizing, daydreaming and wishful thinking or euphoria.
• less participation in a 12-step program or dropping out altogether.

Cure

Talk to your sponsor, go to meetings, meditation, trust your Higher Power and don’t drink.

Falling Back: The Dry Drunk Syndrome Discussion Guide

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Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) – awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses – accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Authors: Carrico AW, Gifford EV, Moos RH. Spirituality/religiosity promotes acceptance-based responding and 12-step involvement. Drug Alcohol Depend. 2007 Jun 15;89(1):66-73

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ACOA Mutual help groups, perceived status benefits, and well-being: A test with adult children of alcoholics with personal substance abuse problems.

A field experiment was conducted to examine the potential effects of mutual help group participation on perceived status benefits, depression, and substance use among 82 adult children of alcoholics (ACOA’s; aged 22-60 yrs) with personal substance abuse problems.

Participants were randomly assigned to attend either ACOA-specific mutual help group meetings or substance abuse education classes during the initial month that they were enrolled in a residential treatment program for low-income substance abusers.

Analyses were based on assessments made at baseline, a 1-month posttest, and a 6-month follow-up.

Results indicate that participation in the mutual help group promoted perceived status benefits, which in turn led to reductions in depression and substance use.

These findings have clear implications for consumers of ACOA groups and can inform research on the social psychological underpinnings of different types of mutual help groups.

Kingree, J. B; Thompson, Martie. Mutual help groups, perceived status benefits, and well-being: A test with adult children of alcoholics with personal substance abuse problems. American Journal of Community Psychology. Vol 28(3), Jun 2000, 325-342.

The Complete ACOA Sourcebook: Adult Children of Alcoholics at Home, at Work and in Love by Janet Woititz Read more about this title…

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A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse. The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

“Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA,” said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. “Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it.”

Added co-author John F. Kelly: “There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome.” Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

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